MEDICARE: LYN BROWN OXLEY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT001073	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073688115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYN BROWN OXLEY OD

Provider Business Mailing Address
First Line	:	PO BOX 406
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30475-0406
Country	:	US
Telephone Number	:	912-537-4447
Fax Number	:	912-537-2743

Provider Business Practice Location Address
First Line	:	104 ANDREW ST STE 112
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-7241
Country	:	US
Telephone Number	:	912-537-4447
Fax Number	:	912-537-2743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	03/17/2018

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